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Managing glaucoma in developing countries

2011; Conselho Brasileiro de Oftalmologia; Volume: 74; Issue: 2 Linguagem: Inglês

10.1590/s0004-27492011000200001

1678-2925

Mauro T. Leite, Lisandro M. Sakata, Felipe A. Medeiros,

Retinal Imaging and Analysis

HOW BIG IS THE PROBLEM?A recent estimate of the number of people affected by glaucoma worldwide suggested that by 2020 there will be approximately 80 million people with the disease, of which 11 million will be bilaterally blind (1) .Due to the paucity of information on disease prevalence in Latin America, estimates of prevalence for this region have been derived mostly from studies conducted in Hispanic populations living in the United States (1) .These extrapolated prevalence rates are likely to be inaccurate, particularly in Brazil, due to its heterogeneous and highly racially-mixed population.Very few data are available on the prevalence of glaucoma in the Brazilian population.A recent population based-study conducted in the south of Brazil found an overall glaucoma prevalence of 3.4% (95% CI: 2.5% to 4.3%) in a sample of 1,636 subjects over 40 years of age.Open-angle glaucoma (OAG) was the most common form of the disease with an estimated prevalence of 2.4%, which increased sharply with aging, achieving 4% in those 60 years of age or older (2) .Interestingly, almost 90% of the glaucoma patients were not aware of their diagnoses, a number that is much higher than estimates of disease awareness previously reported for developed countries, which have been close to 50% (3)(4)(5) .As the population in developing countries ages, the number of individuals with glaucoma will increase, likely worsening the socio-economic burden of the disease.According to the United Nations estimation, the number of Brazilians over 60 years old is estimated to grow from approximately 20 million people in 2010 to 64 million in 2050 (6) .That would represent an increase from 800,000 people with OAG in 2010 to approximately 2.6 million in 2050.It is important to emphasize that a study of glaucoma prevalence conducted in the south of Brazil may not be able to fully characterize the burden of the disease in the whole country, due to the highly heterogeneous ethnic composition of the Brazilian population according to the regions of the country.For example, in the study of Sakata et al., 71% of the examined sample was self-declared as White.Non-Whites tended to show a higher prevalence of OAG and also a higher rate of blindness from the disease compared to Whites, although estimates of prevalence and blindness in non-Whites were largely imprecise due to the small sample size (2) .It is likely that the overall numbers on prevalence and burden of the disease would be different had the study been conducted in the northern parts of the country.Population-based epidemiologic studies are essential in order to provide information on the magnitude of the problem so that adequate strategies can be planned to deal with it.Such studies can be very costly and, therefore, support from government agencies or other forms of federal or private support are essential to ensure adequate funding.